When Efforts to Bridge the Digital Divide Fail, Don’t Blame Patients

Aug 29, 2022

The VA recently offered a program which issued devices to veterans to be able to take part in virtual visits; see the excellent overview from John Lynn. The full OIG report is here: https://www.va.gov/oig/pubs/VAOIG-21-02668-182.pdf

The goal of the program was to bridge the digital divide that existed for many veterans who didn’t have the right device or connectivity to receive virtual care. While the distribution of devices was somewhat successful, program goals had much room for improvement.

Questions that come to my mind from the patient and carepartner perspective about the (lack of) success of the program:

was a strategy co-created with VA patients & their carepartners who would be participating in this program to better understand specific patient unmet needs?
devices need tech-enabled human touch. I physically go to patients homes prior to their virtual visits to coach them through logging on, troubleshooting various platform updates, pop-ups, connectivity errors, & encouraging patients through their fear of “doing something wrong”. Usually after 3 such visits, I move to a text prior to the appt and text while appt is kicking off to confirm patient has signed on. Prerecording a tutorial video capturing the screen and steps of how to login goes a long way as a reference for the patient too.
was it assessed if patients had a carepartner that could help with logistics and troubleshooting; sometimes the carepartner can better drive the appt scheduling, appt prep, connectivity, and the appt conversation to support a patient that is too sick?
depending on the patient’s condition & level of carepartner support, patients benefit from pre-appt prep: a brief discussion on the PURPOSE of the scheduled appt, goals of care (short & long-term), and questions (i.e., what is keeping you up at night, what is frustrating you at the moment, etc).
are patients being coached through the use of their medical records, shown how to review them, supported in understanding them, encouraging them to review them for mistakes & reporting mistakes, coached through how to use the power of the health information to help guide their care? This is one of the most important pieces of the puzzle.
how was trust addressed & were steps included to build trust in the devices that were issued to patients? Many patients who were offered devices may be struggling with serious sensitive diagnoses & building trust is key.

From my review of the full OIG report, none of the above was done. Providing a device is not enough. Patients deserve better care, especially our VA patients who served our country.

When Efforts to Bridge the Digital Divide Fail, Don’t Blame Patients

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